Workshop Summary One Health Zoonotic Disease Prioritization for Multisectoral Engagement in

Bamako, Mali

CS 287568-A ONE HEALTH ZOONOTIC DISEASE PRIORITIZATION FOR MULTISECTORAL ENGAGEMENT IN MALI

Photo 1. Baobab tree at sunset, , Mali

PARTICIPATING ORGANIZATIONS Members from multiple sectors attended as voting members, observers, facilitators, and organizers. The list below indicates the participating organizations; however, a complete list of participants can be found in the appendix. CNASA: Centre National d’Appui à la Santé Animale ASCOMA: Association des Consommateurs du Mali / National Center for Support of Animal Health, / Consumer Association of Mali Ministry of Livestock and Fisheries CDC: U.S. Centers for Disease Control and CT/MESRS: Conseiller Technique du Ministère de Prevention l’Enseignement Supérieur et de la Recherche CNAM: Centre National d’Appui à la Lutte contre Scientifique / Technical Adviser in the Ministry of la Maladie/ National Center for Support of Disease Higher Education Scientific Research Control, Ministry of Health and Public

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DCSSA: Direction Centrale des Services de la Santé IMC: International Medical Corps des Armées / Central Directorate of Army Health INRSP: Institut National de Recherche en Santé Services Publique / National Institute of DGPC: Direction Générale de la Protection Civile / Research, Ministry of Health and Public Hygiene General Directorate of Civil Protection, Ministry of IPR/IFRA: Institut Polytechnique Rurale/Institut Security and Civil Protection de Formation et de Recherche Appliquée / Rural DNA: Direction Nationale de l’Agriculture / National Polytechnic Institute / Institute of Training and Directorate of Agriculture, Ministry of Agriculture Applied Research DNACPN: Direction Nationale de l’Assainissement LCV: Laboratoire Central Vétérinaire / Central et de la Lutte contre les Pollutions et les Nuisances Veterinary Laboratory National Directorate of and the Fight MA: Ministère de l’Agriculture / Ministry of against Pollution and Nuisances Agriculture DNEF: Direction Nationale des Eaux et Forêts / MDAC: Ministère de la Défense et des Anciens National Directorate of Water and Forest, Ministry Combattants / Ministry of Defense and Veterans of Environment, Sanitation and Sustainable Development MEADD: Ministère de l’Environnement, de l’Assainissement et du Développement DNS: Direction Nationale de la Santé / National Durable / Ministry of Environment Sanitation Directorate of Health and Sustainable Development DNSV : Direction Nationale des Services Vétérinaires MEP: Ministère de l’Elevage et de la Pêche / Ministry / National Directorate of Veterinary Services of Livestock and Fisheries ECTAD: FAO Emergency Centre for Transboundary OPV: Office de la Protection des Végétaux /Office of Animal Diseases Plant Protection FAO: Food and Agricultural Organization P&R: Projet Préparation et Réponse / Preparedness FETP: Field Training Program and Response Fondation Merieux VSF-B: Vétérinaires Sans Frontières Belgique / ICD: Initiative Commune pour le Développement / Veterinarians Without Borders Belgium Joint Initiative for Development ICER-SEREFO: International Center for Excellence in Research

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Photo 2. A man walking his dromedary camel at dusk.

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TABLE OF CONTENTS

Participating Organizations ...... ii

Summary ...... 2

Introduction ...... 4

Workshop Methods ...... 7

Plans and Recommendations ...... 8

Appendix A: Overview of the One Health Zoonotic Disease Prioritization Process ...... 11

APPENDIX B: Participants of the One Health Zoonotic Disease Prioritization Workshop, Bamako, Mali ...... 12

APPENDIX C: Zoonotic Disease List Considered in One Health Zoonotic Disease Prioritization Workshop and Resulting Scores ...... 14

APPENDIX D: Ranked Criteria, Corresponding Questions, and Answers with Assigned Weights ... 15

References ...... 17

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SUMMARY

The purpose of this 2-day workshop was to identify zoonotic diseases of greatest national concern for Mali using a One Health approach with input from representatives of human health, livestock, agriculture, and environmental sectors. In preparation for the workshop, representatives identified a list of zoonotic diseases relevant for Mali. Before the workshop, representatives from the different sectors refined the list of diseases for consideration. During the workshop, they defined the criteria for prioritization and determined questions and weights relevant to each criterion. Mali’s prioritized zoonotic diseases were identified using the One Health Zoonotic Disease Prioritization (OHZDP) tool, a semi-quantitative selection tool developed by the U.S. Centers for Disease Control and Prevention (CDC) (Appendix A) 1,2. At the workshop, representatives from Mali (Appendix B), prioritized the following five diseases: anthrax, bovine , , viral hemorrhagic fevers (including Crimean-Congo hemorrhagic fever, Ebola, Lassa, Marburg, Rift Valley fever, and yellow fever) and zoonotic influenza (Table 1). The final results of the OHZDP Tool, including normalized weights for all zoonotic diseases discussed in Mali, are shown in Appendix C. This report summarizes the One Health process used to prioritize the top zoonotic diseases for Mali that should be jointly addressed using a multisectoral, One Health approach including human, livestock, agriculture, and environmental sectors.

Photo 3. One Health Zoonotic Disease Prioritization Workshop participants from human, livestock, agriculture, and environmental health sectors in Bamako, Mali.

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Table 1. Prioritized Zoonotic Diseases Selected in Mali during the One Health Zoonotic Disease Prioritization Workshop in October 2017

Zoonotic Causative Diagnostics, Treatment, Disease Agent Human Disease Burden Animal Disease Burden and Prevention Anthrax Anthrax is in Mali. The primary source of Effective animal and human The last major reported for anthrax is vaccine and treatment for outbreak among people was soil. Animals in Mali and in people exist5, 6. The Central in Kati and resulted in 84 the region are commonly Veterinary Laboratory of human cases and 19 deaths3. infected with anthrax, Mali produces the animal particularly during the anthrax vaccine. dry season4. Bovine Bacteria The exact number of human Bovine tuberculosis is Effective treatment for tuberculosis cases of bovine tuberculosis considered highest in humans is available. in Mali is unknown; however, intensive peri-urban Tuberculosis is prevented in crude estimates production farms where people by controlling the suggest that at least 1.5% of bovine skin tests show 19% of infection in animals and by the population is infected7. animals are positive8. Abattoir boiling or pasteurizing milk studies show pulmonary and dairy products. In Mali, lesions in 1.9% of cattle9. as in most countries in the region, vaccination in animals is not a common practice. Rabies Virus Between 2007-2012, 40 Mali’s Central Veterinary Effective animal vaccines human cases of rabies were Laboratory has documented exist. Post-bite vaccines in reported in Mali; however, 447 animals (435 dogs, 4 cats, humans can be effective if this is believed to be a 4 cows, and 4 monkeys) as given early enough. Once substantial underestimation being positive for rabies symptoms begin, all patients of the burden due to from samples submitted die12. insufficient disease between 2000-201311. surveillance10. Viral Virus Viral hemorrhagic fevers are Viral hemorrhagic fevers are Vaccines exist for yellow hemorrhagic serious diseases that can be present in animals in Mali. fever virus and Ebola fevers (including fatal. There were 8 human Malian cattle show 66% virus16. The antiviral Crimean–Congo cases and 6 deaths caused by seropositivity to Crimean- ribavirin has been used for hemorrhagic Ebola virus in Mali during the Congo hemorrhagic fever15. some viral hemorrhagic fever, Ebola, 2014-2016 outbreak in West In September 2016, outbreaks fevers; however, treatment Lassa, Marburg, Africa1. In September 2016, of Rift Valley fever were is largely supportive17. Rift Valley fever, outbreaks of Rift Valley fever registered in Niger, close yellow fever) were registered in humans to Mali’s northern border in Niger, close to Mali’s and waves of abortions and northern border14. deaths among livestock were reported14. Zoonotic Viruses Zoonotic influenza viruses Influenza viruses have been Oseltamivir (Tamiflu™) influenza have the potential to cause documented in both swine can reduce mortality in global pandemics. Mali and avian populations in people with H5N1 and has reported 40 human cases West Africa19. been shown to control in 2010 following the H1N1 disease outbreaks for pandemic18. avian influenza subtype H720. Otherwise, treatment for people is mainly supportive21.

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INTRODUCTION Zoonotic diseases are diseases that spread between animals and people. Most known human infectious diseases and about three-quarters of newly emerging originate from animals. Mali is a land-locked country located in West Africa. MALI It is bordered by Mauritania and Algeria to the north, Niger and Burkina Faso to the east, Côte d’Ivoire and to the south, and Senegal to the west. Mali has 10 administrative regions (Kayes, , , Ségou, , , Tombouctou, Kidal, Taoudénit, and Ménaka) as well as the District of Bamako, which has a special administrative status. The population of Mali was estimated to be 17,885,245 in 2017, with 51% of the population being female, 67% being people under 25 years of age, and only 3% being people of plants are considered endemic to Mali: Leptadenia over 60 years of age. Most of the population resides waillyi, Elatine fauquei, Pteleopsis habeensis, Hibiscus in the southern part of the country and along the pseudohirtus, Acridocarpus monodii, Gilletiodendron . The average annual population growth had, Brachystelma medusanthemum, and Pandanus rate is 3%22. raynalii. There are several national parks within Mali, including the Mandingue highlands classified forest, Sixty-four percent of Mali’s area is rural. Two Faya Forest Reserve, Bafing National Park, Bougouni- major rivers flow through Mali: the Niger and the Yanfolila wildlife reserve, and Boucle du Baoulé Senegal. The country has four bioclimatic areas in National Park24. Mali’s wildlife is characterized by a 49 agroecological zones in addition to the inner diversity of species and a relatively small number Niger Delta, characterized by specific ecosystems. of staff to protect them. It has more than 136 From north to south, there are: the Saharan species of mammals25, including 70 species of large zone in the north, which covers two-thirds of mammals. Forty-two species live in the Western the country, with annual rainfall less than 150 Savanna and the Sahel region. Some of these mm; the Sahelian zone in the center, with rainfall species are currently declining or regionally extinct. between 200 and 550 mm; the Sudanian zone to There are at least 640 species of birds, of which 15 the south, with rainfall varying from 600 to 1,200 are considered rare. Migratory birds spend 75% of mm per year; and the Sudano-Guinean zone in their time in the Niger Delta, where they protect the southernmost part of the country, with rainfall themselves from the harsh winter and prepare to averaging more than 1,200 mm per year. The face their journey to Europe. They take advantage inner Niger Delta, in the center of the country, is of the abundant food and breed between two characterized by a Sudano-Sahelian climate with migrations. The country’s rivers are rich with nearly rainfall between 200 and 600 mm per year and 143 species of fish belonging to 67 genera and 26 hydrologic and specific ecologic conditions 23. families26. Mali is a country with considerable natural Mali’s economy, dominated by the informal sector, resources and a wide variety of species. It has 1,739 is based on primary production (agriculture, spontaneous woody plant species distributed livestock, fishing and aquaculture), which covers between 687 genera from 155 families. Eight species

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almost 80% of the active population. The potential hampered by zoonoses and endemic transboundary benefits of the agricultural sector are enormous but its development is hampered by zoonoses since 43.7 million ha of land are used for agriculture and endemic transboundary diseases such as and livestock, on which 5.2 million ha (11.9%) are contagious bovine pleuro-pneumonia, rinderpest, cultivated annually. Less than 300,000 ha receive pasteurellosis, Newcastle disease, foot and mouth water sources other than rain, with 120,000 ha disease, and lumpy skin disease. Additionally, sheep completely relying on irrigation27. and goats are widely distributed and adapted to many agroecological zones. Most livestock in Mali has the second largest animal population of Mali are produced in extensive production and the Economic Community of West African States smallholder systems where they co-exist freely with (ECOWAS) and the largest of the West African wildlife. Mali is characterized by wildlife co-existing Economic and Monetary Union (WAEMU). According side-by-side with livestock and humans, especially to statistics from the minister in charge of livestock in rural areas, providing a perfect setting for the in 2016, the breakdown of livestock is as follows: emergence and spread of zoonotic diseases. 10,622,750 cattle; 36 million sheep and goats; 1 million camels; 38,587,450 chickens, of which more than 90% are backyard poultry; and 1.5 million ONE horses and donkeys. The pig population is estimated Following the 2010 Tripartite Concept Note of the at less than 100,00027. The livestock sector accounts FAO-OIE-WHO28 and the recommendations from for 15% of Mali’s GDP. Mali exports about 20% of the ministerial meeting held in Dakar in November its animal products to several countries in West 2016, there was interest from the Government of Africa, including Côte d’Ivoire, Ghana, and Nigeria. Mali to develop a National One Health collaboration Therefore, the livestock sector is a key component platform. In Mali, four primary ministries were of the Malian economy, but its development is included in this planning: the Ministry of Health and Public Hygiene, the Ministry of the Environment Sanitation and Sustainable Development, the Ministry of Livestock and Fisheries, and the Ministry of Agriculture. The Ministry of Agriculture was included in Mali specifically due to the large population involved in agropastoralism and specific diseases related to crops. These four ministries were the key institutions, and the Government of Mali identified an additional eight ministerial departments that were deemed to be essential for One Health collaboration. One or more focal points and alternates from each ministry and relevant department were appointed, totaling 46 focal points. On October 31, 2016, the Government of Mali held a workshop that included all representing ministries and departments, during which decisions were made regarding the National One Health Platform. The Ministry of Health took the lead on the One Photo 4. A colorful chameleon.

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Photo 5. Young child carrying home live chickens.

Health effort, however, an inter-ministerial decree A One Health Zoonotic Disease Prioritization was needed to formalize the One Health Platform Workshop was identified by national representatives among all government parties. The One Health from Mali as the first step toward addressing Platform would be organized via a governing the public health challenges associated with secretariat with a steering committee and it would zoonotic disease threats. To begin to address be additionally divided into thematic groups with these challenges, a One Health Zoonotic Disease technical experts under a technical committee. As Prioritization Workshop was conducted on October of October 2017, following the agreed roadmap, 25-26, 2017, at the Radisson Blu Hotel in Bamako, a draft decree has been developed and is under Mali. The purpose of this 2-day workshop was to review by the key ministries involved in One Health identify zoonotic diseases of greatest national for approval and signature. concern in Mali using input from representatives from the human health, agriculture, livestock, and Zoonotic diseases that occur in large numbers environment sectors. The goal of the prioritization primarily can impact Malian society in three process was to use a multisectoral, One Health main ways: approach to prioritize endemic and emerging • Threaten the health of animals resulting in zoonotic diseases of major public health concern illness, loss of productivity, and death. that should be jointly addressed by ministries • Threaten the livelihood of a large segment of responsible for human, animal, and environmental the population dependent on livestock as a health. It was supported by the Government of Mali, major source of income, particularly women and CDC, FAO, USAID, and the P&R project as part of the smallholders in rural areas. Global Health Security Agenda (GHSA). In efforts • Threaten the health of people with the ability to build in-country capacity to conduct future One to cause a large number of illnesses and deaths, Health Zoonotic Disease Prioritization Workshops, which is associated with significant social six local government representatives from the instability and economic losses human, animal, and environmental health sectors were trained by CDC and FAO as facilitators and also served as the facilitators during the workshop.

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Photo 6. Goats wandering in front of the Great Mosque of Djenne in Mali.

The in-country facilitator training took place on and comment. Through multiple revisions with October 23-24, 2017, at the Radisson Blu Hotel in subject matter experts from these ministries and Bamako, Mali. All but one voting members of this departments and further input from the facilitator workshop were in attendance for the training. training participants, the list was refined to include 38 zoonotic diseases. These zoonotic diseases WORKSHOP METHODS formed the final list for prioritization during the Prioritization Process workshop. See Appendix C for a complete list of the zoonotic diseases used for prioritization and their The prioritization process involved application of resulting scores. CDC’s One Health Zoonotic Disease Prioritization Tool1, 2. Preparations for the One Health Next, during the workshop, voting members jointly Zoonotic Disease Prioritization Workshop began identified five criteria for quantitative ranking of more than two months in advance. FAO these 38 zoonotic diseases. The five criteria were: coordinated the in-country Mali team and CDC’s gravity of the disease, capacity for intervention, One Health Office organized and coordinated socioeconomic impact, bioterrorism potential, and activities for the workshop. presence of the disease in Mali and neighboring countries. Once criteria and questions were chosen, The first step of the process was to identify a each voting member individually ranked the relative country-specific list of potential zoonotic diseases of importance of each criterion to generate a final concern. This was achieved in a multi-step process. group of weighted criteria. The ministry focal points of GHSA in Mali met with P&R and generated an initial zoonotic diseases list One categorical question for each criterion was for prioritization. The zoonotic diseases from Mali’s selected through group discussion. All questions reportable animal diseases list as well as from the had either yes/no answers or ordinal multinomial Mali Epidemiology Bulletin were compared to this answers, with weights assigned to each answer. list and missing diseases were added. A single These questions were developed and agreed upon draft list was compiled from these sources and was through group consensus. Data for answering the shared with all participating organizations for review questions for each of the 38 zoonotic diseases were

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questions, answers and corresponding scores. The list of zoonotic diseases and their normalized scores was presented by the national facilitators to the group (i.e., voting members, observers, and organizers) on the second day of the workshop for discussion. After discussion among the various sectors, the voting members from all represented government departments agreed on a final list of priority zoonotic diseases or disease groups for Mali: anthrax, bovine tuberculosis, rabies, viral hemorrhagic fevers (Crimean-Congo hemorrhagic fever, Ebola, Lassa, Marburg, Rift Valley fever, yellow fever), and zoonotic influenza. Criteria Selected for Ranking Zoonotic Diseases The criteria for ranking zoonotic diseases selected by the voting members in Mali are listed in order of importance below. See Appendix D for the weighted criterion, questions, and answers.

1. Severity of the Disease 2. Capacity of Intervention 3. Socioeconomic Impact 4. Bioterrorist Potential 5. Presence of the Disease

Photo 7. A woman washing a gourd. PLANS AND RECOMMENDATIONS identified through an extensive literature search, Following the agreement of the prioritized including information from the government of Mali, diseases, the workshop participants identified WHO, OIE, FAO, CDC, USAID, and online sources such next steps and further actions that could be as ProMED and HealthMap. If disease information taken by each sector to engage in a One Health, for a particular disease was not available for Mali multisectoral approach. Participants were specifically, regional or global data were used. asked to make general recommendations for how to approach the priority diseases without A decision tree tool developed within Microsoft considering the constraints. They were then Excel™ was used for determining the final disease asked to identify specific activities that their ranking. Each weighted criterion was applied across sectors and organization could accomplish. The all diseases, and scores were assigned based on the recommendations for additional actions are response to each question. The scores for all five described below. questions were summed and then normalized such Collaboration that the highest final score was 1. See Appendix C for the list of 38 diseases and corresponding scores, h For each of the prioritized zoonotic diseases, as prioritized by the OHZDP Tool. See Appendix D specific surveillance and response plans will for a complete listing of all criteria, criteria ranking, be developed and integrated between all sectors, if ones do not already exist.

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h In the development of these surveillance Scientific Research and response plans, the ministries will h Multisectoral, collaborative scientific research capitalize on the existing achievements will be pursued with a focus on one or more in multisectoral collaboration and of the five prioritized diseases. cooperation, and will purposefully avoid • Reinforce Laboratory and Surveillance Capacity creating redundant systems. h Laboratory tests will be made available at the • Development of Human Resources peripheral levels for improved diagnosis of h The notion of One Health, Une Seule the five prioritized diseases. Santé, will be promoted in a multisectoral h Training and continuing education programs way through a national celebration/day will be conducted for laboratory personnel of awareness for One Health, rabies, and on the topic of the five prioritized diseases. other prioritized diseases. h Systems of packaging, shipping, specimen h Personnel will be trained in biosecurity transportation methods, and referral will be and biosafety across sectors in order to improved for the prioritized diseases. strengthen the country’s ability to safely h Systems of detection, notification, and handle and diagnose the prioritized response will be enhanced in a multisectoral zoonotic diseases. way for the prioritized diseases. h The five prioritized diseases and disease groups will be emphasized in trainings within each ministry and for collaborative trainings with multiple sectors.

Photo 8. A boy enjoying the rain in Mali.

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Photo 9. A woman picking papaya.

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APPENDIX A: Overview of the One Health Zoonotic Disease Prioritization Process U.S. Centers for Disease Control and Prevention: Overview of the One Health Zoonotic Disease Prioritization Workshop https://www.cdc.gov/onehealth/global-activities/prioritization-workshop.html

Five Steps for CDC’s One Health Zoonotic Diseases Prioritization Tool and Workshop BEFORE THE WORKSHOP PREPARE FOR THE WORKSHOP • Contact the CDC One Health Office at least 60 days before the workshop STEP • Work with in-country leadership to identify 8 to 12 voting members from all relevant sectors to participate in facilitated group work 1 • Clearly define the purpose and goal of the workshop with all sectors to be represented • Generate a list of all endemic and/or emerging zoonoses to be considered for ranking; include input from all represented sectors » Note: Involves gathering reportable diseases lists

DURING THE WORKSHOP STEP DEVELOP CRITERIA • Identify 5 to 8 criteria that will be used to define the relative national importance of the list 2 of zoonoses; criteria should be locally appropriate and agreed upon by voting members

STEP DEVELOP QUESTIONS 3 • Develop one categorical question for each of the selected criteria STEP RANK CRITERIA • Each voting member individually ranks the selected criteria; individual scores are 4 combined to produce an overall ranked list of criteria STEP PRIORITIZE ZOONOTIC DISEASES • Score each zoonotic disease based on the answers to the categorical questions for each 5 weighted criterion using the One Health Zoonotic Disease Prioritization Tool • Discuss next steps for multisectoral engagement for prioritized zoonoses WORKSHOP OUTCOMES • Prioritized list of at least 5 zoonotic diseases that are agreed upon by all stakeholders at the end of the workshop • Discussions about next steps for the prioritized zoonoses in terms of identifying areas for OUTCOMES multisectoral engagement in developing control and prevention strategies • Workshop summary that includes the details of the process, the list of prioritized zoonoses, and discussions and recommendations by the participants on how to jointly address capacity building, prevention, and control of prioritized zoonotic diseases • Final report, approved by all ministries representing core voting members, within a few months of workshop completion For more information, visit www.cdc.gov/onehealth

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APPENDIX B: Participants of the One Health Zoonotic Disease Prioritization Workshop, Bamako, Mali Voting Members Name Title/Position Organization Abdoul Karim SIDIBE Physician / Chief, Division of DNS, Ministry of Health and Epidemiological Surveillance Public Hygiene Seydou DIARRA Physician / Head of the INRSP, Ministry of Health and Bacteriology Department Public Hygiene Mamoudou KODIO Physician / Laboratory Manager CNAM, Ministry of Health and Public Hygiene Seydou DARA Veterinarian / Program Officer DNSV, Ministry of Livestock and Fisheries Abdallah TRAORE Veterinarian / Laboratory Manager LCV, Ministry of Livestock and Fisheries Soumaïla SANTARA Veterinarian / Head of Risk Assessment CNASA, Ministry of Livestock and Fisheries Department Karim COULIBALY Professor of Secondary Education / Head DNACPN, Ministry of the Environment, of the Communication Sector Sanitation, and Sustainable Development Madame Maiga Awa Cherif Water and Forestry Engineer / Planning DNEF, Ministry of the Environment, DOUMBIA Officer with Area of Interest in Hunting Sanitation, and Sustainable Development Sékou CISSE Agricultural and Rural Engineer / Program DNA, Ministry of Agriculture Manager Dr Issa BARADJI Veterinarian / Technical Advisor Ministry of Higher Education and Scientific Research Dr Mamadou Moussa DIARRA Veterinarian / Professor of Animal Health IPR/IFRA, Ministry of Higher Education and Scientific Research Observers Name Title/Position Organization Médecin Col. Aïssata MAIGA Physician / Chief of the Division of Medical Aid DGPC, Ministry of Security and Civil Protection Dr Abasse SANOGO Physician / Military DCSSA, Ministry of Defense and Veterans Dr Lassina DOUMBIA Physician Faculty of Science and Technology (Laboratory of Zoonoses), Ministry of Higher Education and Scientific Research Cheick Abdel Kader FOFANA Architect ASCOMA Professeur Massambou SACKO Disease Control Adviser Representative of the World Health Organization (WHO) in Mali Dr Aliou KAYO Technical Officer IMC Mohamed GADIAGA Project Manager Mérieux Foundation Dr Fatou SAMAKE Director ICD Veterinarians Without Borders Belgium Dr Adama DAOU Public Health Doctor, Member of the Order of Physicians of Mali National Council of the Order

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Facilitators Name Title/Position Organization Dr Souleymane DIARRA Physician / National Coordinator, GHSA INRSP, Ministry of Health and Public Hygiene Adama DIAWARA Physician / Head of the Emergency Operations CNAM, Ministry of Health and Public Department / Public Health Hygiene Dramane DAO Veterinarian / Chief, Epidemiological DNSV, Ministry of Livestock and Fisheries Surveillance Section Satigui SIDIBE Veterinarian / Chief, Diagnostic and LCV, Ministry of Livestock and Fisheries Research Service M. Thieman DRAME Water and Forestry Engineer / Chief, Hunting, DNEF, Ministry of the Environment, Beekeeping, Game, and Forest Focus Area Section Sanitation, and Sustainable Development M. Oumar SY Agricultural and Rural Engineer OPV, Ministry of Agriculture Dr Lassina OUATTARA Veterinarian / Country Team Leader, ECTAD FAO Mali Dr Karen ALROY Epidemiologist CDC Dr Julie R. SINCLAIR One Health Liaison to OIE CDC/ World Organization for Animal Health Dr Issa BARADJI Veterinarian / Technical Advisor Ministry of Higher Education and Scientific Research Dr Mamadou Moussa DIARRA Veterinarian / Professor of Animal Health IPR/IFRA, Ministry of Higher Education and Scientific Research Organizers Name Title/Position Organization Lionel GBAGUIDI Regional One Health Technical Advisor (ROHTA) P&R Dr SYLLA Djénéba SY Technical Advisor P&R Dr Jean KAMATE Medical Officer / Public Health Advisor CDC Mali Celia WOODFILL DGHP Country Director CDC Mali Karen KOPRINCE Acting Health Office Director USAID Mali Stephanie MARTZ Technical Advisor GHSA USAID Mali Sidi Yeya CISSE Health Policy Advisor USAID Mali Mahmoudou DIALL Veterinarian / National Coordinator ECTAD FAO ECTAD Mali Lassina DOUMBIA Veterinarian / Expert Epidemiologist ECTAD FAO ECTAD Mali Alhousseini DICKO Veterinarian / Animal Science Expert FAO Mali Anou There Thérèse THERA Operations Assistant FAO Mali Dr Bouyagui TRAORE Physician / Coordinator Mali FETP Coordination Team Dr Ken KAYEMBE Physician Mali FETP Coordination Team Grace GORYOKA Health Scientist CDC, One Health Office Dr Casey BARTON BEHRAVESH Director CDC, One Health Office

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APPENDIX C: Zoonotic Disease List Considered in One Health Zoonotic Disease Prioritization Workshop and Resulting Scores Zoonotic diseases considered for prioritization in Mali: Final results of prioritization and normalized weights for 38 zoonotic diseases. The top prioritized zoonotic diseases selected by the voting members representing all ministries active in zoonotic disease work are shown in bold.

Normalized Normalized # Disease Final Score # Disease Final Score 1 Anthrax 1.00 21 Leptospirosis 0.30 2 Rift Valley fever 1.00 22 Pasteurellosis 0.30 3 Rabies 0.93 23 Toxoplasmosis 0.28 4 Zoonotic influenza 0.85 24 Dracunculiasis 0.27 (including avian influenza and swine influenza) 25 Cutaneous and visceral 0.27 5 Ebola virus disease 0.84 leishmaniasis 6 Yellow fever 0.71 26 Severe acute respiratory syndrome 0.27 7 Bovine tuberculosis 0.71 (SARS) 8 Brucellosis 0.70 27 Contagious ecthyma 0.26 9 Lassa fever 0.68 28 Contagious vesicular stomatitis 0.26 10 Marburg hemorrhagic fever 0.62 29 Cowpox 0.22 11 Colibacillosis 0.52 30 Erysipeloid 0.19 12 Salmonellosis 0.43 31 Listeriosis 0.19 13 Q Fever 0.38 32 Lyme disease 0.19 14 Borreliosis and recurrent tick fever 0.37 33 Tularemia 0.18 15 Crimean-Congo hemorrhagic 0.33 fever 34 Lymphocytic choriomeningitis 0.15 16 Botulism 0.33 35 Bartonellosis 0.11 17 Ascaridosis 0.31 36 Trichinellosis 0.11 18 Taenia solium 0.31 37 Bubonic plague 0.07 19 Taenia saginata 0.31 38 Psittacosis 0.04 20 Trypanosomiasis 0.31

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APPENDIX D: Ranked Criteria, Corresponding Questions, and Answers with Assigned Weights

Criteria A: Severity of the disease (0.35) Question: What is the lethality in humans? Answer: >50% (3) 6-49% (2) 0-5% (1)

Criteria B: Capacity of intervention (0.17) Question: Does the country of have available capacity for diagnosis, vaccine or treatment in humans or animals? Answer: All three capacities (3) Two of the three (2) One of the three capacities (1) No capacity in humans nor animals (0)

Criteria C: Socioeconomic impact (0.13) Question: What is the socioeconomic impact of the disease? Answer: Impact on both mortality and productivity in animals (3) Impact on mortality in animals (2) Impact on productivity in animals (1) No impact (0)

Criteria D: Bioterrorism potential (0.08) Question: Is the disease on the list of select bioterrorism agents? Answer: Yes (1) No (0)

Criteria E: Presence of the disease (0.26) Question: Has the disease been present in Mali and neighboring countries over the past 10 years? Answer: Present in Mali (2) Present in the sub-region (1) Not present in Mali or the sub-region (0)

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Photo 10. A boy carrying a goat.

16 BAMAKO, MALI ONE HEALTH ZOONOTIC DISEASE PRIORITIZATION FOR MULTISECTORAL ENGAGEMENT IN MALI

REFERENCES 1. U.S. Centers for Disease Control and Prevention. Overview of the One Health Zoonotic Disease Prioritization. 2017 [cited 2017 April 12]; Available from: https://www.cdc.gov/onehealth/pdfs/zoonotic- disease-prioritization-workshop.pdf. 2. Rist, C.L., C.S. Arriola, and C. Rubin, Prioritizing zoonoses: a proposed one health tool for collaborative decision-making. PLoS One, 2014. 9(10): p. e109986. 3. Simaga SY, A.E., Thiero M, Baylet R., A focus of human and animal anthrax in the area surrounding Kati (Republic of Mali) 20 de la Societe de pathologie exotique et de ses filiales, 1980. 73(1): p. 5. 4. Food and Agriculture Organization. Anthrax outbreaks: a warning for improved prevention, control and heightened awareness. 2016; Available from: http://www.fao.org/3/a-i6124e.pdf 5. Heiman F. L. Wertheim, P.H., John P. Woodall Anthrax, in Atlas of Human Infectious Diseases, H.P. Wertheim HFL, Woodall J, , Editor. 2012, Wiley-Blackwell: Hoboken, NJ. 6. U.S. Centers for Disease Control and Prevention. Anthrax Prevention. Available from: https://www.cdc. gov/anthrax/medical-care/prevention.html. 7. Mamadou Diallo, B.D., Moumine Sanogo, Antieme C. G. , Anou M. Somboro, Mariam H. Diallo, Bréhima Traoré, Mamoudou Maiga, Younoussa Koné, Karim Tounkara, Yeya dit Sadio Sarro, Bocar Baya, Drissa Goita, Hamadoun Kassambara, Bindongo P. P. Dembélé, Sophia Siddiqui, and S.D. Robert L. Murphy, Souleymane Diallo, Anatole Tounkara and Mamadou Niang, Molecular identification of Mycobacterium bovis from cattle and human host in Mali: expanded genetic diversity. BMC Veterinary Research, 2016. 12(1). 8. Sidibé S, D.N., Fané A, Doumbia RM, Sidibé CK, Kanté S, Mangané O, Konaté B, Koné AZ, Maïga MS, Fofana M. , Tuberculose bovine au Mali: résultats d’une enquête épidémiologique dans les élevages laitiers de la zone périurbaine du district de Bamako. Revue d’élevage et de médecine vétérinaire des pays tropicaux, 2003. 56: p. 1. 9. Müller B, S.B., Bonfoh B, Fané A, Smith NH, Zinsstag J. , Molecular Characterization of Canine Rabies Virus, Mali, 2006–2013. Emerging Infectious Diseases, 2016. 5. 10. Mosimann L, T.A., Mauti S, Léchenne M, Obrist B, Véron R, Hattendorf J, Zinsstag J. , A mixed methods approach to assess animal vaccination programmes: The case of rabies control in Bamako, Mali. Acta Tropica, 2017. 165: p. 12. March 2017) 11. Traoré A, P.-M.E., Mauti S, Biarnais M, Balmer O, Samaké K, Kamissoko B, Tembely S, Sery A, Traoré AK, Coulibaly AP. , Molecular characterisation of Mycobacterium bovis isolated from cattle slaughtered at the Bamako abattoir in Mali. BMC Veterinary Research, 2008. 4(1). 12. National Association of State Public Health Veterinarians. Compendium of Animal Rabies Prevention and Control, 2016. 2018 [cited 2018 January 1, 2018]; Available from: http://nasphv.org/Documents/ NASPHVRabiesCompendium.pdf 13. U.S. Centers for Disease Control and Prevention. 2014-2016 Ebola Outbreak in West Africa. Available from: https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html. 14. World Health Organization. Rift Valley Fever in Niger. Available from: https://www.who.int/csr/don/24- november-2016-rift-valley-fever-niger/en/

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15. Maiga O, S.M., Rosenke K, Kamissoko B, Mertens M, Sogoba N, Traore A, Sangare M, Niang M, Schwan TG, Maiga HM. , Serosurvey of Crimean-Congo Hemorrhagic Fever Virus in Cattle, Mali, West Africa. The American Journal of Tropical Medicine and Hygiene, 2017. 96(6): p. 4. 16. Ana Maria Henao-Restrepo, I.M.L., Matthias Egger, Natalie E Dean, W John Edmunds, Anton Camacho, Miles W Carroll, Moussa Doumbia, Bertrand Draguez, Sophie Duraff our, Godwin Enwere, Rebecca Grais, Stephan Gunther, Stefanie Hossmann, Mandy Kader Kondé, Souleymane Kone, Eeva Kuisma, Myron M Levine, Sema Mandal, Gunnstein Norheim, Ximena Riveros, Aboubacar Soumah, Sven Trelle, Andrea S Vicari, Conall H Watson, Sakoba Kéïta, Marie Paule Kieny, John-Arne Røttingen, , Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial. The Lancet, 2015. 386(9996): p. 9 17. Richmond JK, B.D., Lassa fever: epidemiology, clinical features, and social consequences. British Medical Journal, 2003. 327(7426). 18. O. A. Koita, L.S., B. Poudiougou, B. Aboubacar, Y. Samake, T. Coulibaly, P. Pronyk, N. Salez, A. Kieffer., L. Ninove, A. Flahault6 and X. de Lamballerie, , A seroepidemiological study of pandemic A/H1N1 (2009) influenza in a rural population of Mali. Clinical Microbiology and Infection, 2012. 18(10): p. 5. 19. Emmanuel Couacy-Hymann, V.A.K., Gilbert L. Aplogan, Felix Awoume, Casimir K. Kouakou, Lamidi Kakpo, Bridgett R. Sharp, Laura McClenaghan, Pamela McKenzie, Robert G. Webster, Richard J. Webby, and Mariette F. Ducatez, Surveillance for influenza viruses in poultry and swine, West Africa, 2006-2008. Emerging Infectious Diseases, 2012. 18(9). 20. Smith JR., Oseltamivir in human avian influenza infection. Journal of Antimicrobial Chemotherapy, 2010. 65: p. 8. 21. Heiman F. L. Wertheim, P.H., John P. Woodall Avian Influenza (A/H5N1), in Atlas of Human Infectious Diseases, H.P. Wertheim HFL, Woodall J, , Editor. 2012, Wiley-Blackwell: Hoboken, NJ. 22. Central Intelligence Agency. The World Factbook, Mali. 2018; Available from: https://www.cia.gov/library/ publications/the-world-factbook/geos/ml.html. 23. United States Geological Survey, E.R.O.a.S. West Africa: Land Use and Land Cover Dynamics. 2018; Available from: https://eros.usgs.gov/westafrica/node/147. 24. Par L’Essor. Gestion des forêts : Le bon exemple du complexe «Bougouni-Yanfolila». 2014; Available from: https://www.maliweb.net/environnement/gestion-forets-bon-exemple-du-complexe-bougouni- yanfolila-211572.html. 25. International Union for Conservation of Nature, The IUCN Sahel Studies 1989, ed. M.N.G.a.P. Ryden. 1989: IUCN Regional Office for Eastern Africa. 157. 26. Daget, J., Les poissons du Niger Supérieur 1954: Mémoires de l’Institut Francais d’Afrique Noire. 27. Minister of Livestock. 2018, Ministry of Livestock. 28. FAO-OIE-WHO. The FAO-OIE-WHO Collaboration: Sharing responsibilities and coordinating global activities to address health risks at the animal-human-ecosystems interfaces. 2010; Available from: tripartite_concept_note_hanoi_042011_en.pdf.

18 BAMAKO, MALI ONE HEALTH ZOONOTIC DISEASE PRIORITIZATION FOR MULTISECTORAL ENGAGEMENT IN MALI

Photo 10. Sunset at Niger’s River, with a young fisherman in a pinnace in Mali.

BAMAKO, MALI 19 www.cdc.gov/onehealth